Your Full Name*

Your Email*

Your Phone Number*

Right now we have classes on Wednesdays at 12:15pm and complimentary classes every other Saturday at 11am. Would any of this session times fit your schedule?*

What are the 3 things you are worried about not being able to do 10 years from now?*

How would you rate your overall health (energy level, strength and balance)? Poor, fair, good, or excellent?*

Do you have any physical limitations that we need to know about?*

On a scale from 1-10 how motivated are you to make some positive health changes in your life ... 1 = not at all and 10 = highest level of motivation.*

If we were able to help you overcome the mystery of tai chi - and more - with our beginner classes, does $11.25 to $13.50 per 30-minute session, fit into your budget?*

Do you have any other questions or comments?*